Breadth of Knowledge: Initiation and Modification of Interventions (50 of 160 items)

RT · 94 questions

A 62-year-old is on volume control ventilation day 4 for pneumonia, now afebrile with FiO2 0.40, PEEP 5, stable pressure, alert and triggering breaths with adequate cough and minimal secretions. The team wants to advance liberation today during daytime staffing. Which liberation strategy should the therapist initiate to assess readiness for extubation?
A 68-year-old post-surgical adult is stable on a medical floor, breathing comfortably on 2 L/min nasal cannula with SpO2 97%, respiratory rate 16 and clear lungs. The hospital respiratory-driven protocol targets SpO2 92-96% for stable non-ICU patients and allows titration without new orders. Which respiratory-driven protocol step for oxygen titration should the therapist implement next?
In the delivery room a term newborn is limp and apneic after drying and stimulation, heart rate is 55 bpm by stethoscope, and effective positive-pressure ventilation has been given for 30 seconds with chest rise and good seal. The warmer, suction, and code medications are available with a team present. Which neonatal resuscitation intervention should the team implement next for this bradycardic newborn?
An adult with COPD on volume assist-control shows expiratory flow not returning to zero, rising peak pressures, and a scooped inspiratory pressure scalar with patient effort. Blood pressure is soft and breath stacking is seen. Which ventilator adjustment best corrects auto-PEEP with inspiratory flow starvation shown on scalars?
A 42-year-old needs emergent intubation for airway protection with morbid obesity, short thick neck, limited mouth opening, beard, and prior difficult intubation noted. Stridor is present and bag-mask seal is poor. Which difficult airway recognition finding should the therapist report first to prepare the airway team?
A 68-year-old post-stroke patient on a medical floor is lethargic, coughs weakly, pools oral secretions, has right-sided weakness, a diminished gag reflex, and SpO2 91% on room air. Which patient position best optimizes airway patency for secretion drainage?
A 71-year-old is obtunded after stroke with preserved gag, noisy upper airway obstruction, edentulous mouth, and inability to protect secretions during transport to CT. Vital signs are stable but SpO2 is 89%. Which airway device selection and management step should the therapist implement to maintain a patent airway?
On a medical-surgical floor a patient develops sudden stridor and hypotension after antibiotics, the medical emergency team is activated, and multiple responders give overlapping verbal orders in a noisy room. The respiratory therapist is assigned airway management. Which team communication technique should the therapist use to ensure safe execution of emergency orders?
A 24-year-old with cystic fibrosis admitted for exacerbation has thick retained secretions, wheezing, and prescriptions for albuterol, dornase alfa, inhaled tobramycin, and airway clearance. Treatments are clustered and time is limited. Which aerosol medication sequence should the therapist select to maximize deposition and clearance?
A 45-year-old requiring urgent intubation in the emergency department has a short thick neck, limited mouth opening of 2 cm, Mallampati class IV view, beard obscuring landmarks, and a history of prior failed intubation. Which difficult airway recognition action best prepares the team before induction?
A 40-year-old with pneumonia is intubated on PEEP 10 cmH2O and FiO2 0.60 with PaO2 120 mmHg, bilateral infiltrates and no heart failure. The team debates ARDS presence and level. Which severity classification for ARDS using Berlin criteria should the therapist report?
A 58-year-old with moderate ARDS on 6 mL/kg predicted body weight has PaO2/FiO2 135 on FiO2 0.70 and PEEP 10 cm H2O, plateau 27 cm H2O, and no pneumothorax or hypotension. The team considers recruitment. Which lung-protective ventilation approach best supports oxygenation during ARDS with recruitment precautions?
A 55-year-old in the ICU needs an endotracheal tube exchange for a cuff leak with a known anterior airway, full stomach, and SpO2 93% on FiO2 0.60. The team has a video laryngoscope, bougie, and tube exchanger available. Which adjunct strategy should the therapist recommend to use tube exchangers, video laryngoscopes and bougies safely?
A 55-year-old with ARDS and echocardiographic right-ventricular strain remains hypoxemic with elevated pulmonary pressures despite lung-protective ventilation, prone positioning, and stable systemic pressure. The team requests an inhaled pulmonary vasodilator trial. Which delivery method should the therapist select to improve ventilation-perfusion matching?
In a crowded emergency department during a mass-casualty surge, a term newborn is limp, apneic and cyanotic after delivery with no response to drying and stimulation. Staff and warmers are limited. Which high-risk response for neonatal resuscitation and disaster triage should the therapist prioritize first?
A 62-year-old ventilated for pneumonia is now afebrile, hemodynamically stable, on minimal pressure support, with RSBI 58, strong cough, adequate mentation, and a passed 60-minute spontaneous breathing trial on CPAP. Which liberation step best advances mechanical ventilation discontinuation after this successful trial?
A 60-year-old intubated patient with pneumonia on volume control ventilation, PEEP 10 cm H2O and FiO2 0.60, must move from the ICU to CT scan across the hospital with elevators and a 20-minute transport. The patient is sedated but hemodynamically stable. Which transport preparation best ensures safe movement of this ventilated patient within the hospital?
A 58-year-old in the ED is obtunded from overdose, breathing spontaneously with snoring respirations, clenched teeth, and an intact gag and cough. Pulse oximetry is 89% on room air and repositioning alone does not open the airway. Which artificial airway selection best maintains patency with an intact gag reflex?
A 24-year-old with cystic fibrosis is admitted with thick tenacious sputum, wheezing, and prior bronchospasm during mucolytic therapy, requiring daily dornase alfa and scheduled albuterol plus inhaled tobramycin for Pseudomonas colonization. Which aerosol medication sequence should the therapist select to deliver bronchodilators, mucolytics and antimicrobials?
You join a rapid response for a deteriorating patient with stridor where the team leader orders epinephrine, airway equipment, and a room change amid loud overlapping talk. Which closed-loop communication technique best ensures emergency team orders are completed safely during resuscitation?
After a morning rapid-response call where a ward asthma patient required emergency BiPAP and ICU transfer, the mixed nurse-physician-therapist team feels shaken, accounts of delays differ, and family concerns arise. The event ended safely an hour ago. Which debriefing leadership approach should the respiratory therapist initiate first to strengthen safety culture?
A 54-year-old intubated patient in a busy emergency department needs topical anesthesia before fiberoptic bronchoscopy through the endotracheal tube, with copious secretions cleared, preoxygenation completed, and monitoring in place. Which endotracheal instillation technique best delivers medication while preserving oxygenation and sterility?
A 62-year-old ICU patient with a known difficult airway needs exchange of a damaged 7.5 endotracheal tube but must maintain continuous airway access and oxygenation. The team has a video laryngoscope, bougie, and airway exchange catheter available. Which adjunct technique best facilitates safe endotracheal tube exchange in a difficult airway?
On a step-down unit a 58-year-old with a week-old tracheostomy has thick dried crusting at the stoma, low-volume thick secretions, and a soiled reusable inner cannula with intact skin and stable vitals. Which tracheostomy care and humidification action best maintains a patent airway?
A pulmonology team plans bedside bronchoscopy with endobronchial ultrasound in a procedure suite for a middle-aged adult with a right hilar mass, requiring topical anesthesia, moderate sedation monitoring, and multiple needle passes with rapid onsite evaluation. You are assigned to assist. Which assisting action best supports safe intubation-style airway management and EBUS sampling?
A 62-year-old in the ICU after mitral valve repair has pulmonary hypertension, RV dilation on echo, hypoxemia on lung-protective ventilation, and no active bleeding. The team orders a trial of inhaled nitric oxide with continuous monitoring. Which delivery principle should guide inhaled nitric oxide for pulmonary hypertension in this ventilated patient?
A 68-year-old with a cuffed tracheostomy on day 3 has thick tenacious secretions, crusted stoma, low tidal volume alarms on the ventilator, and dry inspired gas. The inner cannula is disposable and humidification is bypassed. Which tracheostomy care routine best restores patency, humidification, and infection control?
A 6-year-old with severe upper airway obstruction in a pediatric emergency bay needs heliox to reduce work of breathing, and a neonate with persistent pulmonary hypertension in the NICU nearby is prescribed inhaled nitric oxide with methemoglobin monitoring. Which administration principle best ensures safe heliox and inhaled nitric oxide delivery?
A 55-year-old on volume control ventilation with PEEP 10 and FiO2 0.60 needs CT across the hospital for suspected pulmonary embolism with only one respiratory therapist and one nurse available. Which intra-hospital transport preparation best maintains safe ventilation and monitoring en route?
On a medical floor a 45-year-old with retained secretions in the left lower lobe is alert with stable vitals, adequate hydration, and no hemoptysis, fractures, or increased intracranial pressure. Which postural drainage, percussion, and vibration technique best clears this lobe?
A 34-year-old asthmatic in an outpatient clinic develops severe wheezing, stridor, chest pain, SpO2 86%, tachycardia 132, and hypotension minutes after starting a nebulized medication with tachyphylaxis unrelieved by repositioning. Which care-plan change best addresses termination for severe adverse events?
In a telemetry unit an adult with a new tracheostomy is gurgling with visible secretions, SpO2 89%, coarse rhonchi, and weak cough but is alert with intact gag and no nasal obstruction or bleeding. Which suctioning approach best clears the airway while limiting harm?
An emergency physician prepares for ultrasound-guided thoracentesis on a dyspneic adult with a large right pleural effusion, with consent signed, platelets borderline low, and SpO2 90% on 2 L nasal cannula. You are asked to assist. Which assisting action best supports safe thoracentesis and chest drainage preparation?
A 28-week preterm infant on mechanical ventilation has increasing FiO2 needs with classic ground-glass appearance and low lung compliance, and the neonatologist orders surfactant replacement through the endotracheal tube during a sterile bedside procedure. Which endotracheal instillation technique should the therapist perform to deliver surfactant?
After a failed emergency intubation with hypoxemia that resolved, the interprofessional team is shaken and blaming each other in the hallway. Which debriefing leadership approach best promotes learning, safety culture, and team recovery after this adverse event?
A 52-year-old with bronchiectasis has coarse crackles and heavy sputum localized to both lung bases, weak spontaneous cough, and stable vitals. The provider orders airway clearance for lower lobe segments. Which postural drainage position with percussion and vibration best targets lower lobe secretions?
A 5-year-old with severe viral croup and inspiratory stridor shows increased work of breathing, barky cough, and poor nebulizer tolerance on room air, and the team requests a low-density gas to reduce airway resistance while maintaining oxygenation. Which heliox and nitric oxide administration setup should the therapist select to relieve obstruction?
A 19-year-old with cystic fibrosis is admitted with increased purulent sputum, SpO2 91% on room air, and fatigue with manual chest physiotherapy. The patient has weak expiratory effort, cannot sustain a huff cough, and peak cough flow is 140 L/min. Vital signs are stable and there is no hemoptysis or pneumothorax. Which airway clearance modality should the therapist select to provide insufflation-exsufflation support?
A 70-year-old with bronchiectasis was started on twice-daily postural drainage with percussion 3 days ago for copious purulent sputum. Today sputum is less than 5 mL per day, breath sounds are clear, cough is nonproductive, and SpO2 is 96% on room air. Which change to airway clearance therapy should the therapist recommend based on this response?
In the ICU a team is placing a radial arterial line and starting moderate sedation for a dyspneic adult needing frequent gases, with continuous pulse oximetry, cardiac monitoring, and nasal cannula oxygen in place. The physician asks respiratory therapy to assist the sterile procedure and sedation. Which assistance action best supports safe arterial catheter insertion with moderate sedation?
A pulmonologist plans bedside bronchoscopy with endobronchial ultrasound for a 58-year-old outpatient with a right hilar mass, mild hypoxemia on 2 L nasal cannula, and no coagulopathy. The team asks respiratory therapy to assist with airway and sampling setup. Which assistance action best supports safe EBUS-guided sampling during the procedure?
A 59-year-old intubated patient in the ICU has coarse rhonchi, visible secretions in the endotracheal tube, and a transient desaturation after coughing, with a sterile suction kit and closed-system catheter available at bedside. Which suctioning technique should the therapist use to clear an artificial airway while preserving oxygenation and sterility?
A tachyarrhythmic adult in the ICU is scheduled for synchronized cardioversion, and in the next room a family has chosen withdrawal of life support with comfort measures only. Respiratory therapy is asked to assist both teams today. Which assistance action best supports safe cardioversion readiness?
A 32-year-old with C5 spinal cord injury has weak inspiratory and expiratory muscles, peak cough flow 155 L/min, retained secretions, and SpO2 90% on room air. The patient is alert, can follow commands, has no bulbar dysfunction or contraindication to manual assistance, and needs a bedside cough strategy before suctioning. Which assisted cough and hyperinflation technique should the therapist apply to improve cough effectiveness?
A 48-year-old on mechanical ventilation develops sudden pleuritic pain, unilateral absent breath sounds, hypotension, tracheal shift, and serum sodium 128 mEq/L with fluid overload from excess hypotonic fluids. Which care plan change best addresses pneumothorax, fluid balance and electrolytes together?
A 67-year-old with COPD receives a first albuterol-ipratropium nebulizer and within minutes develops severe bronchospasm with silent chest, SpO2 81%, hypotension, and widespread hives after an antibiotic change. The mask is still running. Which care plan action best terminates treatment for this severe adverse event?
A 28-year-old with Duchenne muscular dystrophy has recurrent atelectasis, a weak peak cough flow of 150 L/min, difficulty clearing secretions during colds, intact swallowing, and fatigue with manual chest physiotherapy. Which oscillatory or cough-assist intervention best improves secretion clearance for this weak cough?
A 70-year-old intubated patient in the medical ICU after 16 days of ventilation is scheduled for bedside percutaneous tracheotomy. The surgeon requests bronchoscopic guidance, the patient is sedated on volume-control ventilation, and the team is assembling sterile instruments with emergency airway equipment available. Which assisting responsibility should the respiratory therapist prioritize during this tracheotomy insertion?
A 58-year-old intubated for pneumonia has improved infiltrates, is alert, cough is strong, secretions are scant, RSBI 68, passed 30-minute spontaneous breathing trial on pressure support, and cuff leak is audible. Which airway liberation recommendation best fits this extubation readiness?
A 34-year-old with high cervical spinal cord injury has weak inspiratory effort, ineffective cough with peak cough flow 140 L/min, retained secretions, and recurrent atelectasis but intact bulbar function and cooperative participation. Which assisted cough and lung expansion approach should the therapist teach for secretion clearance and volume recruitment?
At shift change in a busy ICU, a therapist must hand off a ventilated adult with ARDS on lung-protective settings, prone-positioning schedule, norepinephrine infusion, and a planned spontaneous breathing trial in the morning. Which handoff communication best ensures continuity and timely escalation of concerns?
A 71-year-old with right middle lobe pneumonia has SpO2 87% on 2 L/min, coarse crackles on the right, productive cough with thick sputum, and ability to turn with assistance. Chest X-ray shows dense right-sided infiltrate without effusion, hemodynamics are stable, and the good left lung is normal. Which positioning and airway clearance combination should the therapist use to minimize hypoxemia?
A 60-year-old in the ICU needs radial arterial line placement for hourly gases and blood pressure monitoring, is alert with a palpable radial pulse, normal Allen test, and no wrist infection. The physician asks respiratory therapy to assist with setup and moderate sedation monitoring if needed. Which assistance sequence best supports safe arterial catheter insertion?
A 55-year-old with acute bronchospasm receives albuterol MDI with spacer, but 30 minutes later wheeze, accessory muscle use and PEF 55% of personal best persist, with heart rate 112 and tremor. The order allows titration. Which therapy change based on response best addresses persistent bronchospasm?
A young adult refugee with limited English proficiency, prior ICU trauma, and worsening asthma needs inhaler teaching before discharge in a crowded emergency department with family present. Which communication approach best demonstrates patient-centered, trauma-informed, culturally aware care?
A 45-year-old with bronchiectasis has thick purulent sputum, wheezing, oxygen need 3 L/min, pulmonary pressures elevated, and poor response to albuterol alone in the step-down unit. Which inhaled medication recommendation best targets secretions, inflammation and vascular tone?
A 59-year-old with community-acquired pneumonia has SpO2 86% on 6 L/min nasal cannula, respiratory rate 32/min, increased work of breathing, PaO2 58 mmHg on oxygen, and no hypercapnia or altered mentation. The patient can protect the airway, has no facial trauma or obstruction, and remains hypotensive-free with adequate perfusion. Which oxygenation support should the therapist initiate and titrate to correct refractory hypoxemia?
A 62-year-old postoperative patient on mechanical ventilation develops sudden right-sided chest pain, absent breath sounds on the right, tracheal shift left, hypotension, and SpO2 84%. Chest x-ray confirms large right tension pneumothorax with mediastinal shift. Labs show K+ 2.8 mEq/L and ionized Ca++ low. Which care-plan change best addresses tension pneumothorax with electrolyte disturbance?
A 62-year-old in the ICU with unstable atrial fibrillation is scheduled for elective synchronized cardioversion. The team asks respiratory therapy to assist at bedside with airway equipment, oxygen and monitoring during procedural sedation. Which bedside assistance step should the therapist complete immediately before shock delivery for safe cardioversion support?
A 68-kg predicted body weight adult with ARDS is on volume assist-control rate 20, VT 550 mL, PEEP 8 cm H2O, FiO2 0.70 with plateau 32 cm H2O, PaO2 68 mm Hg and pH 7.32. Lung-protective goals and oxygenation both remain unmet despite sedation. Which invasive ventilation adjustment best balances lung protection and oxygenation?
A 58-year-old with right lower lobe pneumonia is hypoxemic at 88% on 4-L nasal cannula, alert, with coarse crackles and thick sputum he cannot clear, and chest x-ray shows dense right basal opacity without pneumothorax. Turning is tolerated and hemodynamics are stable. Which positioning and airway clearance strategy best minimizes hypoxemia from retained secretions and mismatch?
A 68-year-old in septic shock on norepinephrine remains hypotensive with MAP 58 mm Hg, lactate 4.2 mmol/L, adequate fluids by dynamic indices, new rapid atrial fibrillation at 150/min, and oliguria with crackles and rising creatinine. Cultures are pending and broad-spectrum antibiotics were started within one hour. Which care-plan medication change best balances perfusion, rhythm, and volume in this shock?
A 58-year-old intubated for pneumonia after 9 days has improving infiltrates, FiO2 0.35, PEEP 5, hemodynamic stability, strong cough, minimal secretions, and passed a 30-minute spontaneous breathing trial with RSBI 68, negative inspiratory force -28 cm H2O, and alert mentation. The cuffed endotracheal tube shows minor cuff leak. Which care-plan change best advances artificial airway liberation and extubation?
In an outpatient clinic a 32-year-old with persistent asthma vapes daily, shares a home nebulizer with a sibling, rinses the cup with tap water, air-dries rarely, and misses doses during colds. The patient wants fewer flare-ups without judgment. Which infection-control, equipment, and cessation education bundle should the therapist provide first?
A 66-year-old with pneumonia is tachypneic and hypoxemic with SpO2 86% on 6-L nasal cannula, alert, protecting the airway, with no hypercapnia or hypotension, in a monitored step-down unit with close supervision. The team wants to avoid intubation if possible while improving oxygenation and work of breathing. Which oxygenation support initiation best improves oxygenation while reducing intubation risk?
A night-shift therapist notes a postoperative patient with rising respiratory rate from 18 to 30, increased work of breathing and SpO2 89% on 4 L after being stable at 94%. The nurse is busy and the rapid response criteria are nearly met. Which handoff and escalation communication should the therapist initiate to address this deteriorating respiratory status?
A 64-year-old ventilated two days after coronary bypass remains on a propofol infusion, RASS -4, hypotensive requiring norepinephrine, with no spontaneous efforts and no awakening trial. The team wants to assess readiness to wean. Which sedative adjustment should the therapist recommend to facilitate weaning evaluation?
In the emergency department, a 69-year-old with severe community-acquired pneumonia was placed on bilevel noninvasive ventilation for hypoxemia and tachypnea. After one hour, RR is 34, SpO2 87% on FiO2 0.60, accessory muscles are active, mentation is drowsy, secretions are copious and blood pressure is 88/54 mm Hg. Which criterion confirms noninvasive ventilation failure requiring escalation?
A 34-year-old with moderate persistent asthma presents with wheezing, prolonged expiration, peak flow 65% of personal best, SpO2 94%, and thick mucus plugging despite good inhaler technique. The patient uses albuterol frequently without controller therapy. Which pharmacologic care-plan change best recommends bronchodilators, anti-inflammatories, mucolytics, and vasodilators?
A 68-year-old with severe COPD on 2 L home oxygen is referred to pulmonary rehabilitation after two exacerbations, reports avoiding walking for fear of breathlessness, demonstrates poor metered-dose inhaler technique without a spacer, and asks how rehab will help daily life. Which pulmonary rehabilitation education strategy best supports COPD self-management and functional improvement for this patient?
A 70-kg predicted body weight adult with ARDS is on volume control ventilation with VT 650 mL, plateau 34 cm H2O, SpO2 86% on FiO2 0.8 and PEEP 8 cm H2O, with bilateral infiltrates and no pneumothorax. ABG shows PaO2 58 mm Hg with permissive hypercapnia tolerated. Which invasive ventilation adjustment best improves oxygenation while ensuring lung protection?
A 34-year-old with prior traumatic intubation is now anxious, tearful and declining a needed nebulizer treatment, citing fear of choking and mistrust of procedures. The therapist has limited time before the next scheduled medication. Which culturally aware, trauma-informed communication should the therapist use to support acceptance of this respiratory treatment?
A 70-year-old in septic shock with pneumonia develops hypotension MAP 58 mmHg, atrial fibrillation with rapid rate, crackles with volume overload, and rising creatinine despite 30 mL/kg fluids and norepinephrine. Cultures are pending and potassium is elevated. Which medication care-plan change best recommends vasoactives, antiarrhythmics, antimicrobials, and diuretics?
A 55-year-old with obesity and loud snoring is drowsy after sedation for a procedure, breathing spontaneously at 10/min with SpO2 89%, soft stridor, and posterior tongue obstruction noted on exam. No cervical spine injury or vomiting is present. Which positioning maneuver best maintains a patent airway in this spontaneously breathing adult?
A 16-year-old with cystic fibrosis and F508del mutation has frequent exacerbations, declining FEV1, chronic Pseudomonas colonization, and difficult asthma-like wheezing despite inhaled steroids. The team discusses advanced therapies including surfactant history, biologics, and modulators. Which medication recommendation best targets the underlying CFTR defect in this CF?
A 2-kg infant with respiratory distress syndrome is on high-frequency oscillatory ventilation with FiO2 0.6 and mean airway pressure 14 cmH2O, with persistent hypoxemia and a low-volume chest radiograph. The high-pressure and low-volume alarms sound briefly during suctioning and repositioning. Which alarm management strategy best supports oxygenation during high-frequency ventilation?
A 68-year-old with COPD exacerbation is on bilevel noninvasive ventilation for hypercapnic failure with pH 7.30 and PaCO2 68. After two hours pressures were titrated and mask leak is minimal, but accessory use worsens and mentation declines. Which noninvasive ventilation failure sign indicates need to escalate to invasive ventilation?
A 68-year-old with COPD exacerbation receives albuterol 5 mg nebulizer every 2 hours, with persistent mild wheeze but new tremor, HR 128 and potassium 3.1, and the nurse asks about the next aerosol. History includes frequent ectopy on telemetry. Which aerosol drug adjustment best balances continued bronchodilation with systemic beta-agonist toxicity?
A 54-year-old man with a BMI of 41 needs urgent intubation for hypercapnic failure. Bedside exam notes Mallampati class IV, thyromental distance under 6 cm, rigid cervical collar, full beard, and loud habitual snoring with witnessed apneas. Which difficult airway recognition conclusion best guides preparation for this intubation?
A 68-year-old with COPD on 2 L home oxygen continues to vape and reports recurrent bronchitis. The apartment smells of cigarettes, the concentrator filter is dusty, tubing lies on the floor, and grandchildren visit weekly. The patient wants practical steps to stay safe at home. Which education plan on infection control, home equipment and smoking cessation best protects this household?
In a surgical ICU a mechanically ventilated adult with agitation and ventilator dyssynchrony receives continuous midazolam and fentanyl without a pain assessment, daily interruption, or train-of-four monitoring, now with prolonged somnolence, hypotension, and weak cough after vecuronium was added for shivering. The team considers prolonged blockade and oversedation risks. Which recommendation best addresses sedatives, analgesics, reversal agents, and neuromuscular blockers for this patient?
A 55-year-old patient with ARDS on volume assist-control ventilation at 450 mL, rate 18, PEEP 10 cmH2O, and flow 60 L/min is agitated, with double-triggered breaths, rising peak pressures, and ventilator rate exceeding set rate on the monitor. Sedation is light, pH is 7.32, and there is no circuit leak or auto-PEEP on exam. Which ventilator adjustment best corrects this patient-ventilator dyssynchrony?
A 67-year-old man with a permanent tracheal stoma after total laryngectomy arrives obtunded and hypoxemic. He has no palpable laryngeal prominence, breath sounds are absent at the mouth, and a fenestrated tracheostomy tube is displaced. Upper airway attempts fail to ventilate. Which airway device management choice best secures ventilation for this laryngectomy anatomy?
A 64-year-old with moderate COPD, frequent wheeze, and a new tracheostomy with home ventilator dependence completes pulmonary rehabilitation intake. The patient misuses inhalers, avoids activity from fear, and family feels unprepared for suctioning and emergency changes. Which education focus on rehabilitation, COPD, asthma overlap, and tracheostomy-ventilator care best builds safety?
A 71-year-old with COPD exacerbation is on 4 L nasal cannula with SpO2 95%, accessory muscle use resolved and ABG pH 7.36 with PaCO2 52, and the respiratory-driven oxygen titration protocol targets 88% to 92% to avoid hyperoxia. The nurse asks if oxygen should stay high for safety. Which protocol-based oxygen titration action best follows evidence-based weaning?
In an adult pulmonary clinic a 32-year-old with severe eosinophilic asthma has two exacerbations and one hospitalization in the past year despite high-dose inhaled corticosteroid plus long-acting beta-agonist, correct technique, and adherence, with blood eosinophils 420 cells per microliter and nasal polyps. A preterm infant and a cystic fibrosis teen are managed separately. Which recommendation best addresses surfactant, asthma biologics, and CFTR modulators for this asthma patient?
A 62-year-old patient with COPD on assist-control ventilation shows scalloped inspiratory pressure-time scalars, concave inspiratory flow with persistent patient effort, and a pressure-volume loop with widened hysteresis, while expiratory flow fails to return to zero with rising intrinsic PEEP. Which ventilator graphics interpretation best identifies the primary problem requiring correction?
A 900-g preterm infant on high-frequency oscillatory ventilation has decreasing chest wiggle, SpO2 82% and a low mean airway pressure alarm. The piston is running, but the circuit shows a leak at the humidifier and the endotracheal tube is mid-trachea. Which high-frequency ventilation response best restores oxygenation and ventilation?
A 48-year-old patient with moderate ARDS from pneumonia has PaO2/FiO2 145 on FiO2 0.7 and PEEP 10 cmH2O, plateau pressure 28 cmH2O, driving pressure 18 cmH2O, and bilateral infiltrates with no pneumothorax or hypotension. The team considers lung recruitment for refractory hypoxemia. Which lung recruitment and lung-protective ventilation strategy best balances oxygenation and safety?
A 58-year-old with pneumonia is on volume control with FiO2 0.60, PEEP 10 cm H2O, PaO2 72 mm Hg and bilateral opacities not explained by effusion or collapse after fluids. The team asks for ARDS severity to guide prognosis and referral. Which Berlin severity classification best fits this oxygenation defect on PEEP?
An obese adult with suspected sleep apnea arrives obtunded with loud snoring, SpO2 86%, chin falling to chest in a supine flat bed, and no cervical trauma. The nurse has an oral airway and positioning aids ready, and the physician requests optimal positioning before assisted ventilation. Which patient positioning technique to optimize the airway best relieves this obstruction?
In a medical ward a 58-year-old with moderate asthma uses albuterol metered-dose inhaler two puffs every four hours with poor relief, nocturnal awakenings, and tremor, with correct spacer technique, normal potassium, and no chest pain. The provider asks respiratory therapy to optimize bronchodilator therapy within protocol. Which adjustment best addresses drug, dose, frequency, mode, or concentration for this patient?
A 45-year-old woman with angioedema requires oral endotracheal tube exchange for a damaged cuff. She has limited mouth opening, anterior larynx, and a Cormack-Lehane grade III view on direct laryngoscopy with desaturation on prior attempts. Which tube exchanger, video laryngoscope, and bougie strategy best ensures safe tube exchange?
An adult on assist-control ventilation shows double-triggered breaths with two stacked ventilator cycles per effort, high tidal volumes and patient distress. Sedation is light, inspiratory time is short, and flow demand is high. Which ventilator adjustment best corrects this patient-ventilator dyssynchrony?